Susan Bartlett Foote

The Impact of Medicare Coverage Policies on Health Care Utilization

OBJECTIVE To determine whether Medicare coverage policies affect utilization of services in Medicare. DATA SOURCES We constructed an analysis data set for eight different procedures using secondary data obtained from Medicare claims (1999-2002) and Medicare coverage policies posted on Center for Medicare and Medicaid Services website. STUDY DESIGN We analyzed the impact of coverage policies using difference-in-difference approach in a regression framework. PRINCIPAL FINDINGS We found that in only one case (transesophageal echocardiography) out of eight did utilization change (reduced by 13.6 percent) after the effective date of the local policies. There is no systematic pattern that policies affect utilization, and the type of coverage policy does not seem to play an important role in its impact. CONCLUSIONS Coverage policies have the potential but do not consistently impact utilization as policy makers intend and expect them to do. These findings raise significant policy questions about the effectiveness of Medicare coverage policies, which deserve further study.

Politics of Prevention: Expanding Prevention Benefits in the Medicare Program

It is critical that public health advocates understand the structure of the Medicare program and the impact of the political process on Medicares benefit set. This article provides an overview of the design of Medicare and its explicit exclusion of prevention benefits in the original legislation. We then provide a history of subsequent legislation authorizing coverage of specific prevention benefits over the last twenty years. We critique the current process in light of innovation in preventive services and the influence of politics in the decision-making. We conclude with a discussion of policy options to improve access to an appropriate range of evidence-based preventive services in Medicare within the context of new technology innovation and rising health care costs.

Coexistence, conflict, and cooperation: public policies toward medical devices.

Medical devices include thousands of products, many of which have greatly contributed to the quality of health care. As devices have proliferated, so have public policies that affect them. The federal government intervened to promote three fundamental values: safety by federal regulation, innovation through federal funding of research and development, and access by providing services under Medicare. The policies generally coexisted without conflict. However, two recent developments--the advent of cost containment and the expansion of the tort liability system--present a potentially disruptive influence on these policies, and threaten to undermine the values they serve. Because cost restraints are inevitable and the tort system provides consumer protection, the challenge for policymakers is to reconcile them with the values of safety, innovation, and access. The proposals presented here seek to promote coordination to protect those values without imposing unacceptable costs on the health care system.